    <div class="col-sm-6 _block-xj _block-quan">
    <div class="contact-box border-xj">
        <div class="col-sm-12">
            <h3 ><strong>现金券-NUMBER</strong></h3>
            <div class="form-group ">
                <label class="col-sm-4 control-label">名称：</label>
                <div class="col-sm-8">
                    <div class="row">
                        <div class="col-md-12">
                            <input type="text" name="xjq[NUMBER][name]" value=""
                                   placeholder="名称" class="form-control">
                            <span class="help-block m-b-none"></span>
                        </div>
                    </div>
                </div>
            </div>
            <div class="form-group  ">
                <label class="col-sm-5 control-label">面值：</label>
                <div class="col-sm-7">
                    <div class="row">
                        <div class="col-md-12">
                            <input type="text" name="xjq[NUMBER][val]" value=""
                                   placeholder="面值" class="form-control">
                            <span class="help-block m-b-none"></span>
                        </div>
                    </div>
                </div>
            </div>

            <div class="ibox-title">
                <h5 class="blue-bg">使用条件<small></small></h5>
            </div>
            <div class="form-group  ">
                <label class="col-sm-5 control-label">起投金额：</label>
                <div class="col-sm-7">
                    <div class="row">
                        <div class="col-md-12">
                            <input type="text" name="xjq[NUMBER][atleast]" value=""
                                   placeholder="起投金额" class="form-control">
                            <span class="help-block m-b-none"></span>
                        </div>
                    </div>
                </div>
            </div>
            <div class="form-group  ">
                <label class="col-sm-4 control-label">期限(天)：</label>
                <div class="col-sm-8">
                    <div class="row">
                        <div class="col-md-12">
                            <input type="text" name="xjq[NUMBER][name]" value=""
                                   placeholder="期限" class="form-control">
                            <span class="help-block m-b-none"></span>
                        </div>
                    </div>
                </div>
            </div>

            <div class="form-group  ">
                <label class="col-sm-4 control-label">有效期：</label>
                <div class="col-sm-8">
                    <div class="row">
                        <div class="col-md-12">
                            <div class="radio i-checks">
                                <label>
                                    <input type="radio" checked="false" value="2" name="xjq[NUMBER][limitype]"> <i></i> 有效天数</label>
                            </div>
                            <div class="radio i-checks">
                                <label>
                                    <input type="radio" checked="false" value="1" name="xjq[NUMBER][limitype]"> <i></i> 截止日期</label>
                            </div>
                        </div>
                    </div>
                </div>
            </div>

            <div class="form-group  ">
                <label class="col-sm-4 control-label">领取后有效天数(天)：</label>
                <div class="col-sm-8">
                    <div class="row">
                        <div class="col-md-12">
                            <input type="text" name="xjq[NUMBER][effectiveDay]" value=""
                                   placeholder="领取后有效天数(天)" class="form-control">
                            <span class="help-block m-b-none"></span>
                        </div>
                    </div>
                </div>
            </div>

            <div class="form-group  ">
                <label class="col-sm-4 control-label">截止日期：</label>
                <div class="col-sm-8">
                    <div class="row">
                        <div class="col-md-12">
                            <input placeholder="截止日期" readonly name="xjq[NUMBER][effectiveDate]" class="form-control layer-date" id="xjq-date-NUMBER">
                            <span class="help-block m-b-none"></span>
                        </div>
                    </div>
                </div>
            </div>

            <div class="form-group">
                <div class="col-sm-4 col-sm-offset-2">
                    <button class="btn btn-white _remove-one-ticket" type="button">移除</button>
                </div>
            </div>
        </div>
        <div class="clearfix"></div>
    </div>
</div>